__________ cells are a result of excess red cell membrane or decreased cell volume and cause the RBCs to look like bulleyes. This can be caused by hemoglinopathies, iron deficiency, drug induced hemolytic anemia, or liver disease

Target

Leukemias generally occur with ___________ or ____________ cells but can involve other cells, including cells in the erythroid or megakaryocytic lineage

1. Myeloid

2. Lymphoid

The ______________ _______ cell also has a Philadelphia chromosome present but generally the cell is quiescent. However, a signal produced by the _____________ _______ cell can trigger proliferation of the pleuripotent stem cell and cause activation of the ______________ stem cell. The result is a _____________ cell crisis in which _______________ will never mature past this stage

1. Pleuripotent stem

2. Myeloid stem

3. Lymphoid

4. Lymphoblast

5. Lymphoblasts (will not form B, T, or NK cells)

___________ ___________ is part of the process of T-cell negative selection that occurs when any developing thymocyte has too high an affinity for the _______ molecule and a self peptide bound to the antigen presenting cell in the thymus. These cells automatically undergo _____________

1. Central tolerance

2. MHC

3. Apoptosis

Follicular lymphoma cells consist of _______________, which are the small cleaved cells and ______________, which are the larger cells that divide more

1. Centrocytes

2. Centroblasts

Diffuse Large B cell Lymphoma:

1. CD markers?

2. Cell lineage?

3. Cell appearance?

4. Response to treatment?

5. Cytogenetic factors?

1. CD19+, CD20+

2. B-cell lineage

3. Cells are larger than a normal lymphocyte with an eradicated normal architecture

What is the result of increased Ig production in RBCs? What condition is associated?

Rouleaux cells

Multiple myeloma

What are the two parts of a bone marrow biopsy?

Aspirate- liquidCore- solid

What is the nl range for myeloblasts in bone marrow?

<5.0

•Red pulp: Red = rich in blood

–Composed of sinusoids (S) and splenic cords (C) called Billroth’s cords, Cords are dead ends; cells are trapped if they can’t squeeze through

–Many monocyte-macrophages (M), Monos/macs are most active here than anywhere else in body

–During extensive red cell damage and splenic activity, blood may enter the spleen but be unable to exit (sequestration)

Describe the function of red pulp in the spleen

What is the difference b/w serum and plasma?

Both are blood without cells.Plasma has clotting factors, serum doesn't.

What is SPEP?

Serum protein electrophoresis

What does SPEP tell you?

peaks for different proteins

a1-a1 antitrypsin

a2-haptoglobin

beta-transferrin, some Igs

gamma-most Igs

What is the #1 protein found in nl blood?

Albumin

What does a positive sickle cell test look like?

Turbid, indicating hemolysis due to sickle shape

List the 5 tissues of the Hematopoietic system:

1. Bone marrow and blood corpuscles

2. Liver

3. Spleen

4. Lymph Nodes

5. Thymus

The _______ __________ is the hollow space of bones filled with all blood cell precursors

Bone marrow

In infants, the bone marrow activity in all bones from skull to feet is ______% cellularity

100%

As we age, cellularity decreases by ___% with decade of life until age 70-80 when cellularity remains at ____-____%

1. 10%

2. 20-30%

List the three sites of bone marrow production in adults:

1. Proximal long bones

2. Chest bone

3. Pelvic bone (site of biopsies)

Draw out the hematopoietic tree

T or F?

Less mature blood cells normally circulate in the peripheral blood

False, only mature blood cells derived from myeloid and lymphoid stem cells should circulate in the peripheral blood

Whole blood is comprised of 55% ___________ and 45% ______ and makes up ___-___% of the total body weight. An average male has ___ pints of blood while the average female has ____ pints of blood

1. Plasma

2. RBCs

3. 7-8%

4. 12

5. 9

List two factors that can stimulate bone marrow production in times of high demand:

1. Infection

2. Low tissue oxygenation

Bone marrow production is mediated by __________ ____________ and an increase in production will result in greater number of mature cells and some young cells, however no _______________ cells are released and activity is _____________ when the demand is met

1. Growth factors

2. Immature

3. Decreased

List three cell types found in the stromal matrix of bone:

1. Fibroblasts

2. Fat cells (appear white)

3. Endothelial cells (line the blood vessels)

A suitable microenvironment for hematopoeisis is provided by the ____________ __________ on which stem cells grow and divide. Also, _____________ molecules and _________ ___________ bound to stromal cells or extracellular matrix provide attachment sites for the stem cells

1. Stromal matrix

2. Adhesion

3. Growth factors

During embryological development, the _______ _____ develops around week ___ and the process of hematopoiesis begins

1. Yolk-sac

2. 3

During embryological development, ______________ cells will differentiate into ______________ cells that line blood vessels while others will differentiate into blood cells themselves

1. Mesenchymal

2. Endothelial

List the five cellular developmental stages observed during erythropoiesis:

1. Pronormoblast

2. Basophilic Normoblast

3. Polychromatophilic Normoblast

4. Orthochromatic Normoblast

5. Reticulocyte

As erythropoetic cell development progresses, the cell size __________, the chromatin in the nuclei _____________, the nucleus to cytoplasm ratio _____________ and the color transitions from ______________ to ______________

1. Decreases

2. Condenses

3. Decreases

4. Basophilic (blue)

5. Magenta (as hemoglobin accumulates)

A normal RBC is ___ microns in diameter with a ______________ disk shape and a __________ ____________ that is approximately 1/3 the diameter of the cell with diminished staining in a blood smear

The main function of RBCs is to pick up _____________ from the lungs and deliver to the tissue and pick up _______ from the tissue and deliver to the lungs

1. Oxygen

2. CO2

RBCs biconcave disk shape gives it a large ____________ _______ that is necessary for gas exchange. Also, the shape of RBCs is highly _____________ which allows them to squeeze through tiny capillaries

1. Surface area

2. Deformable

List the three categories of Leukocytes (white blood cells):

1. Granulocytes

2. Lymphocytes

3. Monocytes

List the three types of granulocytes:

1. Neutrophils

2. Eosinophils

3. Basophils

List the three types of Lymphocytes:

1. T cell (thymus)

2. B cell (bone marrow)

3. Natural Killer (NK) cell

Monocytes will briefly circulate in the blood and then enter the tissue as ________________

Macrophages

List 3 other names for Neutrophils:

1. Polys

2. Polymorphonuclear neutrophil

3. Seg (segmented neutrophil)

List the 6 stages of development for a neutrophil:

1. Myeloblast

2. Promyelocyte

3. Myelocyte

4. Metamyelocyte

5. Band

6. Neutrophil

Like erythrocytes, neutrophilic cells gets ____________ in size and their chromatin _______________ as development progresses

1. Smaller

2. Condenses

Neutrophils function in fighting __________ _____________ and have the capability of phagocytizing small particles by surrounding them with ________________ that fuse and form a _______________. The granules within the neutrophils then fuse with the phagosome and lower the pH to around ____ which activates enzymes and helps kill the digested material

1. Bacterial infections

2. Pseudopods

3. Phagosome/vacuole

4. 4

How long do neutrophils live in the blood? In the tissue?

1. 6-7 hours in the blood

2. 1-4 days in tissue

Neutrophilic granules contain the enzyme ___________________ which is responsible for the green color observed in pus

Myeloperoxidase

Eosinophils have a ____________ nucleus with eosinophilic ___________ and are most often elevated with _______________ infections and _____________ reactions

1. Bilobed (peanut)

2. Granules

3. Parasitic

4. Allergic

Basophils are elevated mainly in ____________ disorders in which the allergen binds to an ______ receptor on the cells and causes a mass release of ______________

1. Allergic

2. IgE

3. Histamine

Monocytes circulate in the bloodstream for approximately _____ hours before entering the tissue to become _______________. Their main role is to ingest fungi, mycobacteria, and pyogenic bacteria. Monocytes can also engulf old RBCs in a process known as __________________

1. 24

2. Macrophages

3. Hemophagocytosis

List the 2 stages of lymphocyte development:

1. Lymphoblast (immature)

2. Lympocyte (mature)

There are no morphologically distinct stages of maturation and an intricate acquisition and loss of surface antigens takes place as cells mature and differentiate into B, T, and NK cells

Lymphocytes are produced in the ______ ___________ where some cells then migrate to other sites of the body to acquire specific properties such as the thymus for ____ cells or remain in the bone marrow and produce ____________ against foreign antigens such as __ cells

1. Bone marrow

2. T cells (suppressor and helper)

3. Antibodies

4. B

Natural killer cells are also known as _________ ________________ lymphocytes

Large granular

Lymphocytes contain very little ______________ and usually do not contain ______________ except as seen in natural killer cells. Their nuclei are about the same size as a _______ and their lifespan is typically measured in _______

1. Cytoplasm

2. Granules

3. RBC

4. Years

The lymphocyte phenotypes includes expression of ___________ of ______________ which are surface antigens that indicate cell lineage commitment and differentiation stage

Clusters of Differentiation

List the Clusters of Differentiation for each cell lineage:

1. B cell Antigens: CD 10, 19, 20, 79a, and sIg kappa and gamma

2. Nk cell Antigens: CD 16, 56

3. T cell Antigens: CD3, 4, 5, 7, 8

Study the CD expression timelines for B and T cells during normal development

________________ are the largest cells in the body that are multinucleated and do not circulate in the body because they would be filtered out by the lung microvasculature. When a piece of this cell is pinched off it forms a ____________ which are approximately 2 microns in diameter

1. Megakaryocytes

2. Platelet

The _________ helps by filtering blood to remove pathogens and senescent or abnormal RBCs

Spleen

The ________ ______ of the spleen is formed by lymphoid nodules within the red pulp. ___ cells form periarterial lymphatic sheaths around the central arteries in the spleen while ___ cells comprise the majority of the lymphoid nodule itself

1. White pulp

2. T

3. B

The _____ _______ is rich in blood and is comprised of ______________ and ____________ ________ also known as Billroth's cords that are both surrounded by _____________-________________ that scavenge pathogens, abnormal, or senescent RBCs

1. Red pulp

2. Sinusoids

3. Splenic cords

4. Monocyte-macrophages

Billroth's cords are like dead end capillaries that filter out old RBCs that cannot deform and squeeze through ________________ in the capillary wall to escape being phagocytized by _________________ in the cord

Heme is comprised of a ring structure called _______________ ___ and an atom of divalent _______ in its ___________ form which allows it to reversibly bind with one molecule of oxygen by sharing an electron

1. Protoporphyrin IX

2. Iron (Fe2+)

3. Ferrous

Each globin chain subunit is comprised of approximately ______ amino acids with slight variations in the sequence of the amino acids that contribute to different types of globin chains

140

The globin genes encoding the alpha chain are located on chromosome ____ whereas the beta, delta, and gamma globin genes are located on chromosome ____

1. 16

2. 11

Humans have two copies of the _______ and __________ globin genes per chromosome for a total of 4 genes per person which suggests that evolutionarily these genes are particularly important

1. Alpha

2. Gamma

During hemoglobin formation, the globin genes are transcribed to _________, which is then translated to a globin polypeptide chain and released into the cytoplasm from the ____________. Each globin chain then binds with a ________ molecule and then forms a ______________ by combining an alpha and non-alpha chain. Finally the two heterodimers combine to form a ______________ known as hemoglobin

1. mRNA 2. Ribosomes 3. Heme 4. Heterodimer 5. Tetramer

Hemoglobin ___ is formed by 2 alpha and 2 beta chains and is the major form of hemoglobin after birth

A

Hemoglobin ____ is formed by 2 alpha and 2 delta chains. However delta chains are not expressed efficiently in the body and therefore only a small amount is present

A2

Hemoglobin ___ is formed by 2 alpha and 2 gamma chains and is sparsely found in F cells during adulthood

F (fetal hemoglobin)

List the 4 types of hemoglobin present during intrauterine development:

1. Gower-1

2. Gower-2

3. Portland

4. F (fetal)

List the two types of hemoglobin present just after birth:

1. F= 60-90%

2. A= 10-40%

Hemoglobins have different charges and therefore will have different mobilities when separated using __________________

Electrophoresis

Hemoglobin A can undergo post translational modification by reacting with various ___________ and __________ groups of the globin chains resulting in a __________ hemoglobin. The most common is Hb ______ where glucose is added to the ______ chain and this is commonly used to monitor long term blood glucose levels

1. Sugars

2. Amino

3. Glycated

4. A1c

5. Beta

The ______ on an oxygen binding curve is the amount of oxygen needed to saturate 50% of the hemoglobin

P50 (Partial Pressure 50)

At low oxygen tension, hemoglobin has a ______ affinity for oxygen whereas at a high oxygen tension, hemoglobin has a _______ affinity for oxygen. This is due to ________________ ____________ of hemaglobin which increases the affinity for oxygen binding as each heme group binds another oxygen molecule

1. Low

2. High

3. Cooperative binding

The ________ effect on Hb binding oxygen states that as the pH decreases (increases H+ concentration) the affinity of Hb for oxygen ______________ causing a shift in the curve to the _________

1. Bohr

2. Decreases

3. Right

___-___ _____________________ is normally found in RBCs and particularly in the tissues. As levels increase, Hb is driven from its relaxed and ______________ state to its tight and _______________ state which will ultimately shift the oxygen dissociation curve to the _______ with increasing levels of 2-3-BPG

1. 2-3 Bisphosphoglycerate

2. Oxygenated

3. Deoxygenated

4. Right

An increase in _____________ during fever will cause the oxygen dissociated curve to shift to the __________

1. Temperature

2. Right

Hemoglobin F has a ___________ affinity for oxygen than Hb A and therefore allows newborns to efficiently shuttle oxygen from the placenta to their tissue. Due to the high affinity of Hb F for oxygen, newborns need a ____________ amount of total Hb in their bodies to efficiently oxygenate their tissue

1. Higher

2. Higher

What are the parts of a hemoglobin molecule?

Globin chains: 2 alpha & 2 non-alpha

4 heme molecules

What are the parts of a heme molecule?

Protoporphyrin IXFerrous (Fe 2+)

•The a genes are on chromosome __

•The b, d, g genes are on chromosome __

1611

•The a genes are on chromosome 16

•The b, d, g genes are on chromosome 11

•Humans have two copies of the a and g genes per chromosome for a total of 4 genes per person

–So they must be particularly important

Describe the globin genes

The Philadelphia chromosome involves a translocation of the _______ gene on chromosome 22 to the ________ gene found on chromosome 9. This leads to the formation of an abnormal _______-_______ gene product

1. BCR (Breakpoint cluster region)

2. ABL (Abelson leukemia virus)

3. BCR-ABL

Humans have two copies of the __ and __ genes per chromosome for a total of 4 genes per person

alphagamma

What chains are associated with Hemoglobin A?Hemoglobin A2?Hemoglobin F?

A: 2 alpha & 2 betaA2: 2 alpha & 2 deltaF: 2 alpha & 2 gamma

- Most common inheritable hematologic disease

- 45% African blacks, 8% US blacks carriers of gene

- survival advantage for malaria

- β6 Glutamate → valine

- with ↓O2 tension or ↓pH, polymerization occurs and leads to RBC sickling

most common is HbA1c (glucose added to beta chain) which can be monitored in diabetics

Process if indirect Coomb's test?

Use pts serum and add other RBCs. If pt’s serum has an antibody that binds an antigen on RBC then you get a complex.

Add an anti-IgG reagent which leads to agglutination.

Which way does low pH shift the O2 binding curve?

right

Which way does 2,3-BPG shift the O2 binding curve?

right (causes release of O2)

RBC metabolism involves production of energy through the ___________-______________ pathway which is an anaerobic glycolytic pathway in which _____________ enters the RBC through facilitated membrane transport system and is metabolized to ___________ _______

1. Embden-Meyerhof

2. Glucose

3. Lactic acid

What is the net gain of ATP from the Embden Meyerhof pathway per glucose molecule consumed?

2 ATP gained (2 invested and 4 produced)

The Embden-Meyerhof pathway produces ___-___ ____________________ which functions to reduce methemoglobin in the __________ form to ___________ iron that can once again bind oxygen

1. 2,3-BPG

2. Ferric (oxidized)

3. Ferrous (reduced)

When oxygen binds to Hb, an electron is partially transfered from ______ to __________. During deoxygenation, sometimes the electron is not returned to the iron molecule generating a _______________ _________ and leaving the iron in its _________ state in which it can NOT bind oxygen. This is when 2,3-BPG helps to reduce the oxidized iron back to its ferrous state

1. Iron to oxygen

2. Superoxide radical

3. Ferric

The __________ ________________ shunt is a side step in aerobic glycolysis that is used to produce NADPH, which is needed to reduce ______________, which is needed to convert _____________ _____________ into water. This pathway relies on the presence of an enzyme called _________ in which a deficiency can lead to oxidative stress int the cell due to the buildup of reactive oxygen species which will ultimately cause RBC _______

1. Hexose monophosphate

2. Glutathione

3. Hydrogen peroxide

4. G6PD (Glucose 6 Phosphate Dehydrogenase)

5. Lysis

What is the most common enzyme deficiency in the world?

G6PD

List the two causes of hemolysis:

1. Intracorpuscular defects

2. Extracorpuscular defects

List three intracorpuscular defects inan RBC that can cause hemolysis:

1. Hemoglobin

2. Cell membrane

3. Embden-Meyerhof Pathway

Problems with any of these components results in intracorpuscular defects resulting in hemolysis

List two types of red blood cell membrane disorders that can cause hemolysis:

1. Hereditary Spherocytosis

2. Hereditary Elliptocytosis

Both intracorpuscular

List two types of red blood cell enzyme disorders that can cause hemolysis:

1. G6PD deficiency

2. Pyruvate kinase deficiency

List four types of red blood cell hemoglobin disorders that can cause hemolysis:

1. Unstable hemoglobins

2. Methemoglobinemia

3. Thalassemia

4. Sickle cell disease

List 5 extracorpusclar defects in RBCs that can cause hemolysis

1. Antibodies to RBC membrane components

2. Sludging, entrapment, and destruction of RBCs in an enlarged spleen

4. Exposure to chemicals with oxidant capabilities in patients with normal Hb or G6PD deficiency

5. Infectious destruction of RBCs (malaria, etc)

Destruction of RBCs within the vascular space is known as ________________ hemolysis whereas destruction of RBCs outside of the vascular space such as the spleen or liver is known as __________________ hemolysis

1. Intravascular

2. Extravascular

Following intravascular hemolysis, free Hb in the plasma will bind to _______________ and the formed complex will be removed by the liver. Some free Hb will break down into alpha-beta dimers that will be filtered by the ________________ and cause hemoglobinuria. Some of these dimers are taken up by renal tubular cells, then broken down, and their iron is stored as _______________. As these tubular storage cells die the levels of hemosiderin can be detected in the urine as a sign of intravascular hemolysis

1. Haptoglobin

2. Glomerulus

3. Hemosiderin

Describe the advantage/disadvantage of HbF

increased O2 affinity to extract O2 from maternal blood

doesn't release as easily, so fetus needs more Hb to adequately oxygenate tissues

What pathway does RBC use for energy?

Embden-Meyerhof

What are the main aspects of the anaerobic metabolism of RBCs?

net gain of 2 ATPs

generates 2,3-BPG

feeds hexose monophosphate shunt

What does 2,3-BPG do?

reduces iron to turn methemoglobin to hemoglobin

Why is the hexose monophosphate shunt important?

uses G6PD to make NADPH which converts peroxide to water, without it there is oxidative damage and cells lyse

What are some things that can be damaged to cause intracorpuscular defects?

Hemoglobin

cell membrane

embden-meyerhof pathway

What are disorders that effect cell membrane?

hereditary spherocytosis

hereditary elliptocytosis

What are some disorders that effect red cell enzymes?

G6PD deficiency

Pyruvate Kinase deficiency

What are some hemoglobin disorders?

unstable hemoglobins

methemoglobin

thalassemia

sickle cell disease

What are some causes of extracorpuscular defects?

antibodies to membrane

traping of rbcs in spleen

trauma (fibrin strands in dic, poor valve fxn)

chemical exposure

infection

What are some causes of intravascular hemolysis?

shear stress from mech. valve

lysis from bacterial toxin

direct trauma

osmotic lysis

complement induced lysis

What happens to lysed rbcs in plasma?

free hb binds to haptoglobin and removed by liver (dec. haptoglobin)

hb broken down and filtered out by kidneys (hemoglobinuria)

broken down hb stored as hemosiderin in renal tubular cells and excreted

List three nutritional requirements for chronic hemolysis and their typical stores found in the body:

1. Folic acid (10 day supply)

2. Vitamin B12 (10 year store)

3. Iron (no supplementation required because it is recycled in the body)

The _________ test helps to identify the presence of antibodies or complement on the surface of RBCs and can either be direct or indirect

Coombs'

Explain the direct Coombs' test:

A patient's RBCs are covered with an IgG antibody or C3d (complement) --> An anti-IgG or anti-C3d antibody is added to the patient's sample of blood --> agglutination of the blood signals a positive test in which the patient has an autoimmune hemolytic anemia (these are observed in lupus, lymphoid malignancies, or can be idiopathic)

Explain an Indirect Coombs' test:

A patient's serum is isolated and added to a sample of "store bought" RBCs --> if the patient has antibodies to an antigen on the RBC then they will bind --> add in a detection agent like anti-IgG --> agglutination signals a positive test meaning the patient has antibodies to an antigen on the RBC (note that antibodies to major blood groups are normal)

List three methods of obtaining blood samples:

1. Venipuncture (peripheral vein puncture)

2. Port: inserted into the subclavian vein and then maneuvered down into the superior vena cava and implanted under the skin

3. Peripherally inserted central catheter (PICC): inserted peripherally in the arm and the tip will rest in the vena cava

T or F?

Blood collection tubes have different colored caps that will keep the blood in a certain state that is important for the kind of blood test to be conducted

True

What stain is used in a peripheral blood smear? Which end of a blood smear do you look at under the microscope?

1. May-Grunwald or Giemsa stain

2. Always observe the thin end of the smear

List the relative percentages for a normal white cell count on a CBC:

1. Neutrophils: 60-70%

2. Lymphocytes: 30-40%

3. Monocytes: 2-10%

4. Eosinophils: 2-4%

5. Basophils: <1%

Remember "Never Let Men Eat Bologna"

What should you do if on a CBC the total white cell count is too high or too low?

Immediately look at the differential to see what subtype of WBC is causing the abnormality

What are the 4 most clinically relevant RBC indices measured on a CBC?

1. Hemoglobin

2. Mean cell volume (MCV)

3. Red cell distribution width (RDW)

4. Platelets

At what stage of life are RBCs most abundant in the body?When does this change?

RBCs, Hb, and hematocrit are highest at birth and then RBC abundacne slowly declines until puberty when it jumps up again with male values exceeding average female values

T or F?

The number of RBCs in the body decreases as a part of normal aging

False, the number of RBCs in the body remains constant after puberty until death

It takes ___ months after birth for fetal hemoglobin (Hb F) to decrease to normal adult levels at around 2%

3

The value of hemoglobin measured on a CBC is given in what units?

Grams of hemoglobin per deciliter of blood

A _____________ measured on a CBC is expressed as a volume percentage of packed RBCs in a given volume of whole blood

Hematocrit (i.e. a hematocrit of 35 means the sample is 35% RBCs by volume)

What value on a CBC tells the relative size of red blood cells?

Mean corpuscular volume

If an MCV is low that means the RBCs are _______________ whereas if the MCV is high that means the RBCs are ________________

1. Microcytic

2. Macrocytic

What CBC value tells the average weight of hemoglobin per cell? What is the unit of measurement?

Mean corpuscular hemoglobin measured in picograms of Hb per RBC

What CBC value tells the average concentration of hemoglobin per cell? What is the unit of measurement?

Mean corpuscular hemoglobin concentration measured in grams of Hb per deciliter of blood

What CBC value tells us how much variation there is in the size of the RBCs? What is normal?

Red cell distribution width

A low RDW is considered normal if the MCV is normal because that means all the RBCs are the same size

Describe the physical differences observed under a microscope between reticulocytes and mature RBCs:

Reticulocytes are slightly larger than mature RBCs and methylene blue can be used to stain precipated RNA in reticulocytes causing them to appear more basophilic. Also, reticulocytes have less central pallor than do mature RBCs

T or F?

Platelet counts are done off a peripheral blood smear observed under the microscope

True

What is the term for an abnormally low level of platelets in a blood smear? What about abnormally high counts?

1. Thrombocytopenia

2. Thrombocytosis

A low mean corpuscular volume (MCV) can be caused by what 5 factors? What is a low MCV typically associated with?

Basophilic stippling of RBCs observed under the microscope is caused by precipitation of undegraded RNA and is a sign of ineffective ________________ often observed in patients with _______ toxicity

1. Hematopoiesis

2. Lead

A _____________ is a RBC that resembles a helmet because a portion of the cell has been pinched off from a fibrin strand as it tried to move past a thrombus in the vasculature

Schistocyte

List two diseases commonly associated with schistocytes:

1. Disseminated intravascular coagulation

2. Thrombotic thrombocytopenic purpura

An ________________ is an RBC that resembles a thorn (spiky) due to disruption in the amount of cholesterol in the RBC membrane. These cells are typically found in patients with _________ disease but can be an artifact on a normal blood smear

1. Acanthocyte

2. Liver

___________ occurs when overproduction of fibrinogen causes an interaction to take place with sialic acid present on the surface of RBCs. This interactions causes stacks or rolls of RBCs to stick to one another

Rouleaux

What 3 diseases are commonly associated with Rouleaux on a blood smear?

1. Multiple myeloma

2. Plasma cell leukemia

3. Infection

In functionally or surgically asplenic patients, remnants of nuclear chromatin in RBCs that are normally removed by spleen macrophages can form __________ ___________ inclusion bodies that are observable on a peripheral blood smear

Howell Jolly

Where is a typical bone marrow biopsy taken on an adult?

The posterior, superior iliac crest of the pelvic bone

T or F?

When conducting a bone marrow aspirate smear, the differential should include normal levels of all precursor cells

True

What is the normal range for myeloblasts in a bone marrow aspirate differential?

<5% myeloblasts

How is cell lineage determined using bone marrow aspirate?

Flow cytometry detecting the different CD surface antigens expressed on these cells

A karyotype and FISH can be conducted on the bone marrow aspirate to determine any chromosomal ________________ that aid in diagnosis and prognosis of bone marrow cancers

Translocations

List the items that are measured with a basic metabolic panel:

1. Sodium

2. Potassium

3. Chloride

4. CO2

5. BUN (blood urea nitrogen)

6. Creatinine

7. Glucose

8. Calcium

List the items that are measured in a comprehensive metabolic panel:

All of the same with the BMP plus:

1. Total protein

2. Albumin

3. AST (aspartate aminotransferase)

4. ALT (alanine aminotransferase)

5. Alkaline phosphatase

6. Total bilirubin

A basic or complete metabolic panel is run using a patients ____________ containing their electrolytes

Serum

Levels of blood protein can be separated and measured by running a ___________ ____________ ____________________

Serum protein electrophoresis (SPEP)

Immunoglobulins are typically measured in the ____________ region of a serum protein eletrophoresis

Gamma

T or F?

Red cells can be lysed and different types of hemoglobin can be separated and quantified using gel electrophoresis

True, different types of hemoglobin will migrate different lengths through the gel based on their differences in molecular weight

Explain how a sickle cell "screen" works:

A sample of blood is mixed with a reducing agent to force the Hb into a deoxygenated state. If the patient has sickle cell their deoxygenated RBCs will begin to sickle and lyse causing a turbid solution to form and indicating a positive "screening" test

List the following for an erythrocyte:

1. Cell size and shape

2. Nuclear size/shape

3. Nuclear color/chromatin appearance

4. Cytoplasm color/appearance

5. Primary function

6. Other names/facts

1. 6-8 microns with biconcave shape to maximize surface area to volume ratio for gas exchange

2. No nucleus or organelles

3. No chromatin

4. Acidophilic (hemoglobin)

5. Oxygent transport

6. Undergo anaerobic glycosis with a lifespan of 100-120 days before being disposed of in the spleen, liver, or bone marrow

-Cytoplasm is basophilic due to abundant polyribosomes and other organelles

-Can often observe a pale staining perinuclear halo

Basophilic erythroblast

Transferrin

Transport: binds to transferrin in the portal blood

-Synthesized in liver, 1/2-life of 8-10 days

-each molecules binds 2 iron atoms

- normally 30% saturated

- Erythroblasts have transferrin receptors, CD71

- Transported to bone marrow for erythropoiesis

- about 6 gs of Hb produced daily

- Total plasma iron turns over about seven times per day

What is Transferrin?

binds to iron in portal blood for transport

-Intermediate in size 12-15 microns

-Nucleus condensed but not homogenous

-Cytoplasm is polychromatic with basophilia from polyribosomes and eosinophilia from hemoglobin

-Perinuclear halo may still be present

Polychromatophilic erythroblast

-Near the same size of an RBC at 10-12 microns

-Nucleus is very condensed and often eccentrically located with pyknotic chromatin

-Cytoplasm more eosinophilic due to higher levels of hemoglobin

-Ultimately divides into a smaller part containing the nucleus that is phagocytosed and a larger reticulocyte that enters circulation

Orthochromatophilic erythroblast

-Less than 10 microns in size

-No nucleus

-Cytoplasm is eosinophilic

-Remnants of organelles and cellular RNA can be demonstrated with special stains

-Matures into an RBC in 1-2 days after entering circulation

Reticulocyte

During erythropoiesis, mitosis continues through the _____________________ erythroblast stage with several cell divisions taking place at each stage of development

Polychromatophilic

It takes approximately ___ ________ for the progeny of a basophilic erythroblast to reach circulation and mature into an erythrocyte

1 week

The protein __________________ is produced and released by the kidney in response to decreased oxygen concentration and functions to increase erythropoiesis by acting on surface receptors of CFU-E cells to drive differentiation

4. Primary function is splitting of small fragment with few organelles and no nucleus to produce platelets

Normally only ___-___% of megakaryocytes in the bone marrow show platelet formation. Once the megakaryocyte begins platelet formation it quickly releases all of its platelets into the _________ _________ in a short period of time and the residual nuclear material in the megakaryocyte is phagocytized by ________________